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COPARTICIPATION AND FRANCHISE
The ANS (National Agency for Supplementary Health) returned and decided to cancel new rules for health plans that share with the client a portion of the care expenses , called coparticipation and franchise. The rules were published on June 28 in resolution 433 and would start counting towards the end of December for new contracts only. Now, however, the agency has determined that they will go through public hearings before they are decided and implemented. There is no date yet for this to happen.
In addition to the monthly payment, the patient pays for a number of consultations and examinations. According to the now revoked document, users may have to cover up to 40% of the value of calls.
The ANS had also stipulated monthly and annual limits for the payment of additional amounts in the joint ownership and franquia (which is similar to car insurance): the maximum amount could not exceed the payment monthly consumer and / or 12 monthly payments in the year.
For example, if the consumer paid R $ 100 per month, the monthly co-participation limit could not exceed R $ 100. So, during the month that there was co-participation, he would pay a maximum of R $ 200.
The withdrawal of the ANS takes place under pressure from entities wanting consumers – who claim not to debate with society – and then that the President of the STF (Supreme Court), Carmen Lúcia, temporarily suspended the resolution in response to a request from the Brazilian Bar Association.
On October 14, the Minister agreed that the ANS badumed jurisdiction "It is strange that the issues relating to the right to health, of such social importance […]are no longer taken into account. account in the appropriate space of appreciation […] by the representatives of the persons legitimately elected to the National Congress, "
DEBATE REUSED
In a note, the l & # 39; regulatory agency stated that she was canceling the changes in the second part.) "because of the apprehension that the theme has caused in society." He understood that he should "reopen the debate and thus better understand the concerns and fears of users of the system. "The ANS is often criticized for making technical and complex decisions without making them sufficiently clear to the population.
Revocation was suggested by the director of development of ANS sector, Rodrigo Aguiar, at an internal meeting of the organ transmitted online. two other directors. The rules governing public administration allow bodies to review decisions according to "convenience and opportunity".
Aguiar felt that the original purpose of the new rules was "to expand consumer protections and promote welfare in society". He admits, however, that there was a "disconnect" between the goals of the agency and the reception of the population.
The ANS product director for standardization and empowerment, Simone Freire, agreed. "It's indeed a salutary step that we take a step back to advance at a time when standards are not understood, what we're talking about is not well understood."
Freire also suggested doing split public hearings, in different locations, to give more opportunities to more people to interact.
The number of users of plans with co-participation and franchise has increased in Brazil. It tripled from 2007 to this year, from 8.3 million to 24.7 million. In January, the percentage of these beneficiaries surpbaded for the first time that of clients who pay only monthly fees.
The measure was celebrated by consumer advocates, who argued that health insurance expenses could double if the resolution came into effect.
In a note, the national president of the OAB, Claudio Lamachia, said that he considered the decision as a victory of the company ", which demonstrates his disagreement with the ANS position, which has adopted the procedure usurping the prerogative of the Congress and did not dialogue with
"The role of the regulatory agencies must be reconsidered urgently: the users, the ultimate end of the provision of public services, were daily injured by some agencies that act as true trade unions defending their commercial interests. "
According to Ana Carolina Navarrete, a researcher at the Idec (Brazilian Institute of Consumer Protection), the retreat demonstrates that ANS is through a crisis of legitimacy. "We read the revocation because of the pressure, without which I think it was difficult for them to go back."
Asked by Folha about Critics, the ANS said that regulation has been discussed several times and a specific technical group was set up in mid-2016.
According to the agency, the theme was the public hearing, the public consultation – which received 1,140 contributions – and opened participation, with 645 suggestions.
FenaSaúde, who represents the largest operators, informed in a note that the decision will allow further discussions. "It's an opportunity for all to make contributions that promote better access of the population to health plans and effectively reduce monthly payments spending to families and businesses."
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